Good Governance and Canadian universities: Fiduciary duties of university governing boards and their implications for shared collegial governance.

Using a legal framework, doctrinal analysis, critical legal analysis, and fundamental legal research and drawing upon legislation, case law, judicial, and scholarly commentary, this article defines the fiduciary duties of Canadian university governing boards given the unique features of the university as a legal entity. Thelegal  analysis considers the Canadian university as a corporation, distinguishing itfrom other types of corporations, identifying the charitable, not-for-profit, public/private dimensions of universities in Canada, and significantly, considering the judicially recognized “community of scholars” and collegial features of universities. The article argues that all of these features shape the fiduciary duties of governing boards and have implications for shared collegial governance in Canadian universities

Education Research in the Canadian Context

This special issue of the International Journal of Education Policy & Leadership (IJEPL), Research in the Canadian Context, marks a significant milestone for the journal. Throughout our twelve-year history, we have sought to publish the best research in leadership, policy, and research use, allowing authors to decide the topics by dint of their research. While this model still serves as the foundation for IJEPL content, we decided to give researchers a chance to engage in deeper conversations by introducing special issues. In our first special issue, researchers discuss their work within the scope of education policy, leadership, and research use within the Canadian context. While many aspects of leadership, teaching, and learning can be seen as similar across contexts, there are also issues of particular concern within national, regional, provincial, or local spheres, particularly when looking at policy and system changes. The researchers featured in this issue provide an important look into education in Canada.PolicyIn the policy realm, Sue Winton and Lauren Jervis examine a 22-year campaign to change special education assessment policy in Ontario, examining how discourses dominant in the province enabled the government to leave the issue unresolved for decades. Issues of access and equity play out within a neoliberal context focused on individualism, meritocracy, and the reduced funding of public services. While Winton and Jervis highlight the tension between policy goals and ideological contexts, Jean-Vianney Auclair considers the place of policy dialogues within governmental frames, and the challenge of engaging in broadly applicable work within vertically structured governmental agencies. One often-touted way to move beyondResearch useWithin the scope of research use, Sarah L. Patten examines how socioeconomic status (SES) is defined and measured in Canada, the challenges in defining SES, and potential solutions specific to the Canadian context. In looking at knowledge mobilization, Joelle Rodway considers how formal coaches and informal social networks nserve to connect research, policy, and practice in Ontario’s Child and Youth Mental Health program.LeadershipTurning to leadership, contributing researchers explored the challenges involved in staff development, administrator preparation, and student outcomes. Keith Walker and Benjamin Kutsyuruba explore how educational administrators can support early career teachers to increase retention, and the somewhat haphazard policies and supports in place across Canada to bring administrators and new teachers together. Gregory Rodney MacKinnon, David Young, Sophie Paish, and Sue LeBel look at how one program in Nova Scotia conceptualizes professional growth, instructional leadership, and administrative effectiveness and the emerging needs of administrators to respond to issues of poverty, socioemotional health, and mental health, while also building community. This complex environment may mean expanding leadership preparation to include a broader consideration of well-being and community. Finally, Victoria Handford and Kenneth Leithwood look at the role school leaders play in improving student achievement in British Columbia, and the school district characteristics associated with improving student achievement.Taken together, the research in this special issue touches on many of the challenges in policy development, application, and leadership practice, and the myriad ways that research can be used to address these challenges. We hope you enjoy this first special issue of IJEPL

Prehospital recognition and antibiotics for 999 patients with sepsis: protocol for a feasibility study

Background: Sepsis is a common condition which kills between 36,000 and 64,000 people every year in the UK. Early recognition and management of sepsis has been shown to reduce mortality and improve the health and well-being of people with sepsis. Paramedics frequently come into contact with patients with sepsis and are well placed to provide early diagnosis and treatment. We aim to determine the feasibility of undertaking a fully powered randomised controlled trial (RCT) to test the clinical and cost-effectiveness of paramedics obtaining blood cultures from and administering IV antibiotics to patients with sepsis, so we can make a decision about whether to proceed to a fully powered randomised controlled trial, which will answer questions regarding safety and effectiveness for patients and benefit to the National Health Service (NHS). Methods/design: This is an individually randomised, two-arm feasibility study for a randomised controlled trial with a 1:1 ratio. Sixty paramedics will receive training to assist them to recognise sepsis using a screening tool, obtain blood cultures, and provide IV antibiotics. If sepsis is suspected, paramedics will randomly allocate patients to intervention or usual care using their next sequential individually issued scratch card. Patients will be followed up at 90 days using linked anonymised data to capture length of hospital admission and mortality. We will also collect self-reported health-related quality of life (using SF-12) at this time. We will interview ten patients by telephone and hold a focus group with paramedics, to find out what they think about the intervention. Discussion: At the end of this study, we will make a recommendation about whether a full randomised controlled trial of paramedics obtaining blood cultures and administering IV antibiotics for sepsis is warranted, and if so, we will develop a proposal for research funding in order to take the work forward

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Randomised feasibility study of prehospital recognition and antibiotics for emergency patients with sepsis (PhRASe)

Severe sepsis is a time critical condition which is known to have a high mortality rate. Evidence suggests that early diagnosis and early administration of antibiotics can reduce morbidity and mortality from sepsis. The prehospital phase of emergency medical care may provide the earliest opportunity for identification of sepsis and delivery of life-saving treatment for patients. We aimed to assess the feasibility of (1) paramedics recognising and screening patients for severe sepsis, collecting blood cultures and administering intravenous antibiotics; and (2) trial methods in order to decide whether a fully-powered trial should be undertaken to determine safety and effectiveness of this intervention. Paramedics were trained in using a sepsis screening tool, aseptic blood culture collection and administration of intravenous antibiotics. If sepsis was suspected, paramedics randomly allocated patients to intervention or usual care using scratchcards. Patients were followed up at 90 days using linked anonymised data to capture length of hospital admission and mortality. We collected self-reported health-related quality of life at 90 days. We pre-specified criteria for deciding whether to progress to a fully-powered trial based on: recruitment of paramedics and patients; delivery of the intervention; retrieval of outcome data; safety; acceptability; and success of anonymised follow-up. Seventy-four of the 104 (71.2%) eligible paramedics agreed to take part and 54 completed their training (51.9%). Of 159 eligible patients, 146 (92%) were recognised as eligible by study paramedics, and 118 were randomised (74% of eligible patients, or 81% of those recognised as eligible). Four patients subsequently dissented to be included in the trial (3%), leaving 114 patients recruited to follow-up. All recruited patients were matched to routine data outcomes in the Secure Anonymised Information Linkage Databank. Ninety of the 114 (79%) recruited patients had sepsis or a likely bacterial infection recorded in ED. There was no evidence of any difference between groups in patient satisfaction, and no adverse reactions reported. There were no statistically significant differences between intervention and control groups in Serious Adverse Events (ICU admissions; deaths). This feasibility study met its pre-determined progression criteria; an application will therefore be prepared and submitted for funding for a fully-powered multi-centre randomised trial.Trial registration: ISRCTN36856873 sought 16th May 2017; https://doi.org/10.1186/ISRCTN36856873.</p

Author Correction: Randomised feasibility study of prehospital recognition and antibiotics for emergency patients with sepsis (PhRASe) (Scientific Reports, (2021), 11, 1, (18586), 10.1038/s41598-021-97979-w)

The original version of this Article contained errors in Table 1 and Table 3. In Table 1, in the group “Already taking antibiotics at emergency call, n (%)”, the number of patients in “Intervention (n = 62)” and “Control (n = 52)” were interchanged. The incorrect and correct values appear below. Incorrect:(Table preseneted.

Randomised feasibility study of prehospital recognition and antibiotics for emergency patients with sepsis (PhRASe)

Severe sepsis is a time critical condition which is known to have a high mortality rate. Evidence suggests that early diagnosis and early administration of antibiotics can reduce morbidity and mortality from sepsis. The prehospital phase of emergency medical care may provide the earliest opportunity for identification of sepsis and delivery of life-saving treatment for patients. We aimed to assess the feasibility of (1) paramedics recognising and screening patients for severe sepsis, collecting blood cultures and administering intravenous antibiotics; and (2) trial methods in order to decide whether a fully-powered trial should be undertaken to determine safety and effectiveness of this intervention. Paramedics were trained in using a sepsis screening tool, aseptic blood culture collection and administration of intravenous antibiotics. If sepsis was suspected, paramedics randomly allocated patients to intervention or usual care using scratchcards. Patients were followed up at 90 days using linked anonymised data to capture length of hospital admission and mortality. We collected self-reported health-related quality of life at 90 days. We pre-specified criteria for deciding whether to progress to a fully-powered trial based on: recruitment of paramedics and patients; delivery of the intervention; retrieval of outcome data; safety; acceptability; and success of anonymised follow-up. Seventy-four of the 104 (71.2%) eligible paramedics agreed to take part and 54 completed their training (51.9%). Of 159 eligible patients, 146 (92%) were recognised as eligible by study paramedics, and 118 were randomised (74% of eligible patients, or 81% of those recognised as eligible). Four patients subsequently dissented to be included in the trial (3%), leaving 114 patients recruited to follow-up. All recruited patients were matched to routine data outcomes in the Secure Anonymised Information Linkage Databank. Ninety of the 114 (79%) recruited patients had sepsis or a likely bacterial infection recorded in ED. There was no evidence of any difference between groups in patient satisfaction, and no adverse reactions reported. There were no statistically significant differences between intervention and control groups in Serious Adverse Events (ICU admissions; deaths). This feasibility study met its pre-determined progression criteria; an application will therefore be prepared and submitted for funding for a fully-powered multi-centre randomised trial. Trial registration: ISRCTN36856873 sought 16th May 2017; https://doi.org/10.1186/ISRCTN3685687

Author correction: Randomised feasibility study of prehospital recognition and antibiotics for emergency patients with sepsis (PhRASe) (Scientific Reports, (2021), 11, 1, (18586), 10.1038/s41598-021-97979-w)

The original version of this Article contained errors in Table 1 and Table 3. In Table 1, in the group “Already taking antibiotics at emergency call, n (%)”, the number of patients in “Intervention (n = 62)” and “Control (n = 52)” were interchanged. The incorrect and correct values appear below. Incorrect:(Table preseneted.)</p

Additional file 1: of Prehospital recognition and antibiotics for 999 patients with sepsis: protocol for a feasibility study

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